Provider Demographics
NPI:1194442772
Name:NUSET CLARKSVILLE
Entity type:Organization
Organization Name:NUSET CLARKSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD/DDS
Authorized Official - Phone:303-501-2212
Mailing Address - Street 1:7991 VANCE DR STE A
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2148
Mailing Address - Country:US
Mailing Address - Phone:303-422-2990
Mailing Address - Fax:
Practice Address - Street 1:12431 CLARKSVILLE PIKE
Practice Address - Street 2:ROUTE 108
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029
Practice Address - Country:US
Practice Address - Phone:410-531-2265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NUSET SILVER SPRING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No292200000XLaboratoriesDental Laboratory